Ply Chichareon1, Rodrigo Modolo2, Hideyuki Kawashima3, Kuniaki Takahashi3, Norihiro Kogame3, Chun-Chin Chang4, Mariusz Tomaniak5, Masafumi Ono3, Simon Walsh6, Harry Suryapranata7, James Cotton8, Rene Koning9, Ibrahim Akin10, Neville Kukreja11, Joanna Wykrzykowska3, Jan J Piek3, Scot Garg12, Christian Hamm13, Philippe Gabriel Steg14, Peter Jüni15, Pascal Vranckx16, Marco Valgimigli17, Stephan Windecker17, Yoshinobu Onuma18, Patrick W Serruys19. 1. Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. 2. Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Internal Medicine, Cardiology Division, University of Campinas, Campinas, Brazil. 3. Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 4. Department of Interventional Cardiology, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands. 5. Department of Interventional Cardiology, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands; First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. 6. Department of Cardiology, Belfast Health and Social Care Trust, Belfast, United Kingdom. 7. Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands. 8. Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom. 9. Cardiology Service, Clinique Saint-Hilaire, Rouen, France. 10. First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience and German Center for Cardiovascular Research Partner Site Heidelberg/Mannheim, Mannheim, Germany. 11. Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom. 12. Department of Cardiology, East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom. 13. Kerckhoff Heart Center, University of Giessen, Bad Nauheim, Germany. 14. French Alliance for Cardiovascular Trials, INSERM U-1148, Hôpital Bichat, Université Paris-Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France; Imperial College and the Institute of Cardiovascular Medicine and Science, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom. 15. Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 16. Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium. 17. Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. 18. Department of Cardiology, National University of Ireland, Galway, Galway, Ireland. 19. Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom. Electronic address: patrick.w.j.c.serruys@gmail.com.
Abstract
OBJECTIVES: This study assessed the ability of the dual-antiplatelet therapy (DAPT) score in stratifying ischemic and bleeding risk in a contemporary percutaneous coronary intervention (PCI) population. BACKGROUND: The DAPT score is recommended by guidelines as a tool to stratify ischemic and bleeding risk. Its utility in contemporary PCI is unknown. METHODS: The study studied patients in GLOBAL LEADERS (A Clinical Study Comparing Two Forms of Anti-platelet Therapy After Stent Implantation) who were free of major ischemic and bleeding events and adhered to antiplatelet strategy during the first year after PCI. The primary ischemic endpoint was the composite of myocardial infarction or stent thrombosis. The primary bleeding endpoint was Bleeding Academic Research Consortium type 3 or 5. Outcomes from 12 to 24 months after PCI were compared according to the DAPT score. RESULTS: Of 11,289 patients that were event-free after the first year, 6,882 and 4,407 patients had low (<2) and high (≥2) DAPT scores, respectively. Compared with a low DAPT score, patients with a high DAPT score had a higher rate of the composites of myocardial infarction or stent thrombosis (0.70% vs. 1.55%; p < 0.0001). The rate of Bleeding Academic Research Consortium type 3 or 5 bleeding was 0.54% and 0.30% in the low and high DAPT score groups, respectively (p = 0.058). The effect of ticagrelor versus aspirin monotherapy on primary ischemic and bleeding endpoints during the second year were no different among the 2 groups. CONCLUSIONS: The DAPT score can stratify ischemic but not bleeding risk in a contemporary PCI population during the second year. The score did not provide additional value for selection of antiplatelet strategy beyond the first year.
OBJECTIVES: This study assessed the ability of the dual-antiplatelet therapy (DAPT) score in stratifying ischemic and bleeding risk in a contemporary percutaneous coronary intervention (PCI) population. BACKGROUND: The DAPT score is recommended by guidelines as a tool to stratify ischemic and bleeding risk. Its utility in contemporary PCI is unknown. METHODS: The study studied patients in GLOBAL LEADERS (A Clinical Study Comparing Two Forms of Anti-platelet Therapy After Stent Implantation) who were free of major ischemic and bleeding events and adhered to antiplatelet strategy during the first year after PCI. The primary ischemic endpoint was the composite of myocardial infarction or stent thrombosis. The primary bleeding endpoint was Bleeding Academic Research Consortium type 3 or 5. Outcomes from 12 to 24 months after PCI were compared according to the DAPT score. RESULTS: Of 11,289 patients that were event-free after the first year, 6,882 and 4,407 patients had low (<2) and high (≥2) DAPT scores, respectively. Compared with a low DAPT score, patients with a high DAPT score had a higher rate of the composites of myocardial infarction or stent thrombosis (0.70% vs. 1.55%; p < 0.0001). The rate of Bleeding Academic Research Consortium type 3 or 5 bleeding was 0.54% and 0.30% in the low and high DAPT score groups, respectively (p = 0.058). The effect of ticagrelor versus aspirin monotherapy on primary ischemic and bleeding endpoints during the second year were no different among the 2 groups. CONCLUSIONS: The DAPT score can stratify ischemic but not bleeding risk in a contemporary PCI population during the second year. The score did not provide additional value for selection of antiplatelet strategy beyond the first year.
Authors: Davide Capodanno; Usman Baber; Deepak L Bhatt; Jean-Philippe Collet; George Dangas; Francesco Franchi; C Michael Gibson; Hyeon-Cheol Gwon; Adnan Kastrati; Takeshi Kimura; Pedro A Lemos; Renato D Lopes; Roxana Mehran; Michelle L O'Donoghue; Sunil V Rao; Fabiana Rollini; Patrick W Serruys; Philippe G Steg; Robert F Storey; Marco Valgimigli; Pascal Vranckx; Hirotoshi Watanabe; Stephan Windecker; Dominick J Angiolillo Journal: Nat Rev Cardiol Date: 2022-06-13 Impact factor: 32.419
Authors: Nino Mihatov; Eric A Secemsky; Dean J Kereiakes; Gabriel Steg; Patrick W Serruys; Ply Chichareon; Changyu Shen; Robert W Yeh Journal: Catheter Cardiovasc Interv Date: 2020-10-28 Impact factor: 2.692